Colchicine intoxication mimicking an acute surgical abdomen: report of a pediatric observation

A 14 year-old girl, treated for Behcet’s disease with colchicine, was referred for acute diarrhea and abdominal pain. She was conscious, afebrile, with the following vital signs: blood pressure: 92/58 mmHg, heart rate: 130 /min, respiratory rate: 22/min, and SpO2: 98% on room air. There was a slight abdominal guarding. Pulmonary and cardiac examinations were unremarkable. Peripheral pulses were symmetrical. Abdominal X-ray did not reveal pneumoperitoneum. Ultrasound examination showed no peritoneal effusion. Despite supportive management and ceftriaxone + metronidazole combination, her abdominal pain worsened and vomiting started. The patient was admitted to the operating room. Midline laparotomy found a few milliliters of peritoneal fluid. Peritoneal lavage with warm isotonic saline was performed. No significant surgical abnormality was observed. The patient was admitted to the pediatric intensive care unit (ICU). Weaning from mechanical ventilator was impossible because of persistent hypoventilation. She developed a progressive paralysis of lower and upper limbs as well as loss of deep tendon reflexes, in the absence of hypokalemia and rhabodmyolysis. Electromyography was normal. Bacteriological cultures were negative. Alopecia appeared on day 2 and pancytopenia was further assessed (platelets: 1 G/L, hemoglobin: 7 g/dl, and white blood cells: 2 G/L) with no abnormal coagulation test. Diagnosis of colchicine poisoning was suspected. Spontaneous neurological recovery was progressive allowing extubation on day 7. The patient disclosed having ingested 24 mg of colchicine (0.6 mg/kg) for a suicidal attempt following an argument with her family. She left the hospital on day 15 after full recovery with a psychiatric follow-up.